Provider Demographics
NPI:1174783013
Name:SHADIS, RYAN MARC (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MARC
Last Name:SHADIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1245 HIGHLAND AVENUE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3727
Mailing Address - Country:US
Mailing Address - Phone:215-887-3990
Mailing Address - Fax:215-887-1140
Practice Address - Street 1:1245 HIGHLAND AVENUE
Practice Address - Street 2:SUITE 600
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3727
Practice Address - Country:US
Practice Address - Phone:215-887-3990
Practice Address - Fax:215-887-1140
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2013-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT188082208600000X
PAMD441695208600000X, 2086S0102X
FLME1140142086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery